Walk-by-Booth Outreach School & Community Program Registration Form

Organization Name

Organization Address

City

State/Province

Zip/Postal

Address for Program Location (if different from Organization Address)

City

State/Province

Zip/Postal

Would you prefer a in-person Walk-by-Booth or a Virtual Program?

Walk-by-Booth (in-person)

Virtual (over digital media such as Zoom)

IF Virtual – would you prefer we create the zoom link or that you do?

We will make the Zoom link and send link to mmgraw@delmns.org

DelMNS will make the Zoom link and attach to contract

N/A: I would like an in-person mobile museum

Contact Name

First

Last

Contact’s Phone Number

Contact’s Email

Program Theme Selection

How many estimated Students/Participants will you have?

How many estimated Teachers/Adults will you have?

Age Range/Grade of Participants

Phone Number for Day of Contact (if different from Contact Phone Number)

Parking Instructions

First Choice Date of Program (Monday-Friday preferred)

Second Choice Date of Program (Monday-Friday preferred)

First Choice Start Time of Program (8:30 a.m.-7:30 p.m.)

End Time of Program (9:30 a.m.-9:30 p.m.)

Do your students/participants have any accessibility needs that we should be aware of? (non-English speaking, non-verbal, mobility needs, special needs, etc.)

We background check all employees and volunteers when they join our team. Does your organization require that DelMNS provide any background checks for our educators? If so, please specify what you require.

Any additional concerns or questions? Please let us know here

How did you hear about us?